Can B.C.’s family doctor shortage be solved?

Vivian Luk, Special to The Sun03.15.2013

B.C. Medical Association president Dr. Shelley Ross says more must be done to train greater numbers of young doctors to become family physicians, which are needed to replace those who will be retiring in the next decade or so.

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Traditionally, being a family doctor didn’t have the cachet of being a specialist, such as a cardiologist or a neurosurgeon. Family doctors tend to earn less than specialists. And they need to know a little bit about every ailment.

Dr. Shelley Ross, who once had a family practice in Burnaby, says it used to be that family doctors would often hear from people, “What kind of specialist are you? Are you just a GP?”

Times have changed.

“Now when they find out you’re a GP, they say, ‘Will you take my mother on as a patient?’” said Ross, president of the B.C. Medical Association.

The chronic shortage of family doctors in B.C. has lifted the status of the general practitioner. According to Ross, roughly 106,000 British Columbians who want a family doctor don’t have one.

Jim Thorsteinson, executive director of the B.C. College of Family Physicians, says the shortage has partly to do with the fact that B.C. historically has not trained as many physicians as other provinces.

$132-million pilot project

Inefficiencies in the system also creates backlog.

“People often will see several different family physicians rather than their main family physician,” he said. “Whoever you’re seeing next time, if it’s not the same person, he doesn’t know your history, so that can create some inefficiencies.”

The provincial government wants every British Columbian to have a family doctor by 2015. Health Minister Margaret MacDiarmid says the government has taken steps to make that happen. The province recruited 268 physicians last year, a 24-per-cent increase from 2011. The number of medical students in B.C. went from 128 in 2001, when the Liberal government came into power, to 288 in 2012. While not all will choose to be family doctors, the numbers are encouraging, said MacDiarmid.

“We went through a time in B.C., where it went as low as … 20 per cent for people choosing family medicine (because) it was not seen as a good job, and people were really moving away from it,” she said. “There’s been a tremendous effort at UBC ... to get those numbers up, to help students understand what it is to be a family doctor and to get them more exposure during their training, and then through that, we have been successful.”

In the province’s more remote communities, programs such as student loan forgiveness and higher wages are helping to keep family doctors in underserved communities, said MacDiarmid.

In February, the province launched a $132-million pilot program in partnership with the BCMA to improve access to primary care. Called “A GP for me,” it allows consultations with doctors to be done over the phone — a move expected to reduce waiting times. The plan also involves recruiting new doctors, establishing more clinics and increasing the use of other health care workers to reduce the workload of family doctors.

Real shortage lies ahead

Ross says other initiatives to improve access include teaching family doctors how to schedule appointments better, and how to manage patients with chronic diseases so they can keep the conditions under control, and thus decrease the chances of having to see them during a crisis.

However, she believes some of those measures are merely Band-Aid solutions.

“We haven’t even seen the (real) shortage yet,” she said. “The average age of a general practitioner in British Columbia is about 40 (years old); the average age of a specialist is about 55. If you look at another 10, 15 years down the road, all the older doctors will be retired.”

Ross believes the government could further integrate care to alleviate workloads. While nurse practitioners and pharmacists are now allowed to do some of the work that was previously done by family doctors, Ross says family doctors could use the help of physician assistants. However, physician assistants are not regulated in B.C. “That’s a common thing done in the United States and in the military in Canada, and we’d very much like to see that in British Columbia,” she said. “What happens is under a doctor’s supervision, they could see patients with certain conditions and be able to deal with it on their own.”

And while the government and UBC are doing what they can to recruit and train more family physicians, Ross says it’s still not enough.

“We have a different generation now, they don’t want to work ... 24/7,” she said. “They want to have a little bit of time for themselves, so it’s going to take more doctors to do the work than what you’ve got now.”

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Can B.C.’s family doctor shortage be solved?

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